Overview

The Nuss procedure is a minimally invasive surgical procedure to correct pectus excavatum, a congenital chest-wall deformity often called sunken chest. Instead of removing cartilage or ribs, the operation lifts the depressed sternum by placing a curved metal bar beneath it. The bar is left in place to remodel the chest wall and is typically removed after a period of years.

Technique and components

Surgery is performed under general anesthesia. Through small lateral incisions a pre-bent steel bar is tunneled behind the sternum and across the chest. Once positioned, the bar is rotated to elevate the sternum into a more normal contour. Stabilizers and sutures may be applied to reduce bar rotation or displacement. Video-assisted thoracoscopic guidance is commonly used to reduce risk and aid accurate placement.

Indications, patient selection, and evaluation

The procedure is most often done in children and adolescents because a more flexible chest wall allows easier correction, but adults can also be treated with modifications. Indications include cosmetic concern and functional symptoms such as exercise intolerance or cardiac/respiratory complaints. Preoperative imaging and measurements such as the Haller index (ratio of transverse to anteroposterior chest diameter) help quantify severity and guide decision-making.

Risks, recovery, and outcomes

Common early issues include postoperative pain, bruising, and limited activity. Pain control can require multimodal analgesia, sometimes including epidural or patient-controlled analgesia. Potential complications include bar displacement, infection, pneumothorax, bleeding, and—rarely—injury to internal organs. Most patients experience improved chest shape and high satisfaction; some report better exercise tolerance and psychosocial benefits. The corrective bar is usually removed after a period (commonly around two to four years) once the chest has remodeled.

History and alternatives

The technique was developed in the late 20th century as a less invasive alternative to open cartilage resection procedures. The classic open repair (Ravitch-type) removes abnormal cartilage and may be preferred in certain complex or rigid deformities, in adults, or when previous surgeries have failed. Surgeons sometimes combine approaches or use multiple bars for severe or asymmetric deformities.

Important distinctions and considerations

  • The Nuss procedure focuses on internal bracing rather than excision of chest wall structures.
  • Best outcomes are achieved with careful patient selection, surgical experience, and structured postoperative care including physical therapy.
  • Long-term follow-up after bar removal is important to monitor recurrence or late issues.

For more detailed surgical descriptions and patient resources see surgical and condition-specific references: procedure overview, condition details, and patient information on sunken chest.